RU2213516C2 - Method for determining indications to applying laser intervention in the cases of open angle glaucoma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves determining indications by carrying out test in which Schlemm's canal blockage nature is to be determined. The laser treatment is indicated to patients having functional blockage of scleral sinus and mixed blockage of sinus. EFFECT: high accuracy of the method. 1 dwg

Description

 The invention relates to medicine, in particular to ophthalmology, and can be used to treat primary open-angle and mixed glaucoma, causing a high percentage of loss of objective vision [2].

 A known method of linear laser trabeculoplasty (LTP) around the entire circumference of the trabecula or adjacent structures [7].

 A known method of phased execution of laser traction operations [3].

 A known method of conducting anterior and posterior trabeculospasis. In this case, laser cauterization is applied in the first case to the inactive part of the trabecula between the Schwalbe ring and Schlemm's canal, and in the second to the scleral spur posterior to the canal [5].

 A known method of radial trabeculoplasty, in which coagulants are applied in one row from the Schwalbe ring to the scleral spur [6].

 However, all the proposed methods were applied without taking into account the pathogenetic mechanisms of the development of open-angle glaucoma, and therefore there was no clear concept of selecting patients for laser trabeculoplasty, therefore, it was impossible to predict the results of the operation.

 The purpose of the invention is to identify the nature of the blockade of Schlemm's canal for pathogenetic selection of patients for LTP.

The specified goal was achieved by the fact that:
1) Along with the traditional examination of the state of the eyes before LTP, patients determined the nature of the blockade of the Schlemm's canal. To do this, all patients underwent pilocarpine test in our modification or glycerol-tonographic test [1]. A total of 179 eyes of patients with I and II stages of glaucoma were examined.

 2) According to the results of this test, all patients were divided into 3 groups. Group 1 (53 eyes) - patients with functional blockade of the scleral sinus, group 2 (102 eyes) - with a mixed block of the sinus, group 3 (24 eyes) - patients with an organic block.

3) All patients underwent linear laser trabeculoplasty according to Weiss in the modification of Mamedov N.G. et al. [4]. It consists in the application of coagulants equidistant from each other on the functionally active part of the trabecular membrane for 270 ^o , the upper segment remained intact. Amount from 100 to 120, energy power from 600 to 1000 mW, exposure time 0.1 s, application size 50 μm. The operation was carried out using an argon laser.

 4) After LTP, patients were observed in dynamics for at least 2 years.

 5) An analysis of the results was carried out according to the main criterion - compensation of intraocular pressure (IOP).

 Compensation of IOP in groups with open-angle glaucoma is presented in FIG. 1, which shows that in the first group, full compensation for IOP occurs in 75.5% (40 eyes), while the appointment of local antihypertensive drugs in another 15.1% (8 eyes), i.e. in the amount of 90.6% of cases. In the group with mixed blockade, respectively, in 63.7% (65), 18.6% (19) and a total of 82.3% of cases. In the group with organic blockade of 41.7% (10), 8.3% (2), the amount of 50.0%.

 Thus, our proposed definition of the nature of the blockade of the Schlemm canal makes it possible to predict the long-term results of laser trabeculoplasty and offer this method to practical doctors as a criterion for selecting patients for laser intervention.

 Examples.

 1. Patient Korolkov VN, 64 years old, was examined on an outpatient basis with a diagnosis of Open-angle I "a" (on myotics) glaucoma of the right eye. Open-angle IV "a" (operated) glaucoma of the left eye. Initial cataract of both eyes. Complains about the gradual decrease in objective vision of the right eye, the lack of objective vision of the left eye.

 Objectively: Right eye - Visus OD = 0.1-4.0D = 0.2. Pigment rim destruction, pseudoexfoliation. In the lens, the initial clouding in the cortical layers. With gonioscopy of schlemm, the channel is filled with blood throughout. Fundus: optic nerve disc - pale pink with a gray tint, extended physiological excavation of 0.5 PD, clear boundaries. Arteries are sclerotic. The field of view is normal. IOP - 27.0 mm Hg True IOP - 20.0 mm Hg. Art. The coefficient of ease of outflow (CLO) is 0.13. The results of the pilocarpine test: IOP - 20.0; true IOP - 14.0; CLOUGH - 0.15. Thus, based on the test results, the blockade of the Schlemm canal is functional.

 09/03/98, made laser trabeculoplasty (LTP) (N-104, P-600, d-50, t-0,1).

 In a month: IOP - 20.0; true IOP - 15.0; CLOUGH - 0.15. After 1 year: IOP - 18.0; true IOP - 11.5; CLOUGH - 0.19. After 2 years: IOP - 19.0; true IOP - 11.0; CLO 0.24; visus OD 0.05-5.0 - 0.2; field of view is the norm.

 Example 2

 Patient Mardanov F.F., 72 years old. He was admitted to the 2nd ophthalmic department of the Republican Clinical Hospital on 12/28/98 with a diagnosis of Open-angle I "glaucoma", initial cataract of the right eye. Initial cataract of the left eye. Complaints about the gradual deterioration of objective vision in both eyes over the past 3 years.

 Objectively: Visus OD = 0.5 right eye does not correct. Pigment rim destruction, pseudoexfoliation. The lens has uneven opacities. The fundus of the eye: the optic disc is pale pink, the borders are clear, physiological excavation. Arteries are sclerosed, veins of normal caliber. The field of view is within normal limits.

 IOP - 29.0. True IOP is 24.0. CLOUGH - 0.09. After the pilocarpine test, the following data: IOP - 25.0; true IOP - 21.0; CLOUGH - 0.105. According to the test results, the blockade of the Schlemm canal is mixed.

 12/29/98, made laser trabeculoplasty (N-114, P-650, d-50, t-0,1).

 One month after LTP: IOP - 20.0; true IOP - 15.0; CLOUGH - 0.11. After 6 months: IOP - 24.0; true IOP - 18.0; CLOUGH - 0.12. The patient was prescribed in the right eye instillation of a solution of timolol 0.5%, 1-2 drops 2 times a day. 1 year after LTP: IOP on timolol - 22.0; true IOP - 16.0; CLOUGH - 0.15. After 2 years: IOP - 18.0; true IOP - 11.2; CLO - 0.19; visus OD = 0.5 does not correct; visual field is normal.

 Example 3

 Patient Makhalova E.F., 68 years old. She was admitted to the 1st ophthalmic department of the Republican Clinical Hospital on December 30, 1998 with a diagnosis of open-angle glaucoma I "in" the right eye. Open-angle glaucoma I "in" the left eye. Initial cataract of both eyes. Complains about the gradual deterioration of objective vision in the right eye over the past year.

 Objectively: Right eye - visual acuity 0.1 + 3.0 = 0.8. The iris is atrophic. On the fundus - the optic disc is gray, the shift of the vascular bundle to the nasal side. Arteries are sclerotic. Intraocular pressure - 28.0. True pressure is 24.0. The coefficient of ease of outflow is 0.09. The results of the pilocarpine test: IOP - 27.0; true pressure - 24.0; the coefficient of ease of outflow is 0.09. According to the results of this test, it turns out that the block of the Schlemm's canal is organic.

 On 5.01.98, laser trabeculoplasty was performed (N-113, P-600, d-50, t-0.1).

 A week later, IOP was within normal limits. A month later: IOP - 22.0; true IOP - 17.0; CLOUGH - 0.145. After 1 year: IOP - 24.0; true IOP - 19.0; CLOUGH - 0.145. The patient additionally performed laser gonioplasty (N-99, P-450, d-200, t-0,1). After 1.5 years: IOP - 25.0; true IOP - 18.9; CLO - 0.17; instillations of a 0.5% timolol solution in the right eye were prescribed; IOP was compensated. After 2 years (on timolol): IOP - 26.0; true IOP - 19.6; CLOUGH - 0.12. The patient is recommended surgical intervention.

Sources of information
1. Vurgaft M.B. et al. Bulletin of Ophthalmology, 1975, 6, C. 12.

 2. Libman E.S., Shakhova E.V., Chumaeva E.A. VII Congress of Ophthalmologists of Russia. Theses of reports, M., 2000, S. 251.

 3. Mamedov N. G., Shtillerman A. L., Bulletin of Ophthalmology, 1984, 3, S. 10-13.

 4. Mamedov N.G., Shtilerman A.L., Frolov A.V., Bulletin of Ophthalmology, 1985, 3, S. 9-12.

 5. Nesterov A.P. et al. Kazan, honey. journal - 1980. - 1. - S. 40-42.

 6. Nesterov A.P., Mamedov N.G., Shtillerman A.L. Kazan., Honey. Zh., 1984. - 5. - S. 357-359.

 7. Wise J. B., Witter S. L., Arch. Ophtalmol., 1979, V. 97, P. 319-322.

Claims (1)

 A method for determining indications for laser intervention in primary open-angle glaucoma by conducting a test, characterized in that they determine the nature of the blockade of the Schlemm's canal, while laser treatment is indicated for patients with functional blockade of the scleral sinus and with a mixed sinus block.

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